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5. Sports Medicine MCQs

Practice Set 25 of 360

This practice set contains high-yield board review questions covering key concepts in 5. Sports Medicine. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 481

Topic: Knee Sports

An 11-year-old boy presents with knee pain. MRI reveals an osteochondritis dissecans (OCD) lesion on the lateral aspect of the medial femoral condyle. The physis is open, and there is no fluid behind the lesion, indicating it is stable. What is the best initial treatment?

. Arthroscopic drilling of the lesion
. Bioabsorbable pin fixation
. Non-weight bearing and activity modification
. Osteochondral autograft transfer (OATS)
. Microfracture

Correct Answer & Explanation

. Non-weight bearing and activity modification

Explanation

Juvenile OCD lesions (open physes) that are stable on MRI have an excellent prognosis for spontaneous healing. Initial treatment consists of activity modification and restricted weight-bearing.

Question 482

Topic: 5. Sports Medicine

Displaced tibial eminence fractures contain the attachment of which of the following structures in addition to the anterior cruciate ligament:

. The lateral meniscus
. The medial meniscus
. The posterior cruciate ligament
. The patellar ligament
. The fat pad

Correct Answer & Explanation

. The lateral meniscus

Explanation

Displaced tibial eminence fractures have been shown by arthroscopy to routinely contain the anterior attachment of the lateral meniscus. In addition, the anterior tibial attachment of the meniscus is torn. The cruciate and the meniscus pull the fragment in different directions.

Question 483

Topic: Knee Sports
A 10-year-old boy sustains a type III avulsion of the anterior tibial eminence. When his knee is placed in extension, the fragment does not reduce. Which of the following factors is likely preventing its reduction?
. Interposed anterior horn of medial meniscus
. Interposed stump of anterior cruciate ligament
. Interposed cartilage flap of tibial plateau
. Increased intra-articular pressure from hematoma
. Opposing pull of cruciate and lateral meniscus

Correct Answer & Explanation

. Opposing pull of cruciate and lateral meniscus

Explanation

Type III tibial eminence fractures usually contain attachments of both the anterior cruciate ligament and the lateral meniscus. The opposing pull of both of these structures often prevents reduction during extension of the knee.

Question 484

Topic: 5. Sports Medicine

A 10-year-old boy with Klippel-Feil syndrome wishes to play contact sports. He has a fusion of C2-C3 but normal neurologic exam. According to current guidelines, what is the most appropriate recommendation?

. Cleared for all contact sports without restriction
. Contraindicated for contact sports due to hypermobility at adjacent segments
. Cleared only if a cervical collar is worn during play
. Contraindicated due to high risk of associated atlantoaxial instability
. Cleared for collision sports if MRI shows no syrinx

Correct Answer & Explanation

. Contraindicated for contact sports due to hypermobility at adjacent segments

Explanation

Patients with Klippel-Feil syndrome typically have congenital cervical fusions leading to compensatory hypermobility at adjacent unfused segments. They are generally restricted from contact or collision sports to prevent catastrophic neurologic injury.

Question 485

Topic: Knee Sports
During reconstruction of the medial patellofemoral ligament (MPFL), an error in femoral tunnel placement can lead to altered graft kinematics. If the femoral tunnel is placed too anteriorly, which of the following is the most likely clinical consequence?
. Graft laxity in flexion and tightness in extension
. Graft tightness in flexion and laxity in extension
. Uniform graft laxity throughout the range of motion
. Uniform graft tightness throughout the range of motion
. Medial patellar subluxation in full extension

Correct Answer & Explanation

. Graft tightness in flexion and laxity in extension

Explanation

Schöttle's point identifies the anatomic femoral attachment of the MPFL. If the femoral tunnel is placed too anterior to the true origin, the graft will become inappropriately tight in flexion, potentially limiting range of motion and increasing patellofemoral pressures.

Question 486

Topic: Knee Sports
A 14-year-old boy presents with a completely displaced tibial eminence (spine) fracture (Meyers and McKeever Type III) after a bicycle accident. What is the most appropriate management?
. Cast immobilization in full extension for 4 weeks
. Cast immobilization in 30 degrees of flexion for 6 weeks
. Arthroscopic or open reduction and internal fixation
. Primary anterior cruciate ligament reconstruction
. Excision of the displaced fragment

Correct Answer & Explanation

. Arthroscopic or open reduction and internal fixation

Explanation

Type III tibial eminence fractures are completely displaced and often have the anterior horn of the medial meniscus interposed, blocking closed reduction. Arthroscopic or open reduction and internal fixation is indicated to restore ACL tension and joint congruity.

Question 487

Topic: Knee Sports

A 16-year-old female presents with recurrent lateral patellar instability. Imaging reveals a tibial tubercle-trochlear groove (TT-TG) distance of 22 mm and a normal Patellar Height Ratio. What is the most appropriate surgical intervention?

. Isolated MPFL reconstruction
. Lateral retinacular release
. Medialization of the tibial tubercle with MPFL reconstruction
. Anteromedialization (Fulkerson) osteotomy
. Distalization of the tibial tubercle

Correct Answer & Explanation

. Medialization of the tibial tubercle with MPFL reconstruction

Explanation

A TT-TG distance >20 mm is a well-established indication for a tibial tubercle medialization osteotomy. Concomitant MPFL reconstruction is typically performed to restore the primary soft tissue restraint to lateral patellar translation.

Question 488

Topic: Knee Sports

The medial patellofemoral ligament (MPFL) is the primary soft-tissue restraint to lateral patellar translation at which of the following knee flexion angles?

. 0 to 30 degrees
. 30 to 60 degrees
. 60 to 90 degrees
. 90 to 120 degrees
. Greater than 120 degrees

Correct Answer & Explanation

. 0 to 30 degrees

Explanation

The MPFL provides approximately 50% to 60% of the restraining force against lateral patellar displacement in early knee flexion (0 to 30 degrees). Beyond 30 degrees, the patella engages the trochlea, and the bony architecture becomes the primary stabilizer.

Question 489

Topic: Knee Sports

Which radiographic sign is pathognomonic for severe trochlear dysplasia and is characterized by the outline of the trochlear floor crossing the anterior contour of the lateral femoral condyle on a strict lateral radiograph?

. Double contour sign
. Supratrochlear spur
. Crossing sign
. Insall-Salvati sign
. Caton-Deschamps sign

Correct Answer & Explanation

. Crossing sign

Explanation

The crossing sign represents the trochlear groove becoming flush with the lateral femoral condyle, indicating a flat trochlea. It is the fundamental radiographic feature of trochlear dysplasia described by Dejour.

Question 490

Topic: Knee Sports

A 12-year-old female gymnast presents with recurrent knee pain. Radiographs reveal a classic osteochondritis dissecans (OCD) lesion. Which of the following is the most common anatomical location for this lesion in the knee?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the medial femoral condyle
. Medial aspect of the lateral femoral condyle
. Lateral aspect of the lateral femoral condyle
. Central trochlear groove

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The classic and most common location for an osteochondritis dissecans (OCD) lesion of the knee is the lateral aspect of the medial femoral condyle. This accounts for approximately 70% of all knee OCD lesions.

Question 491

Topic: Knee Sports

Which of the following physical examination findings is most specific for identifying a torn anterior cruciate ligament in a pediatric or adolescent patient?

. Positive anterior drawer test in neutral rotation
. Positive Lachman test
. Positive pivot shift test
. Positive McMurray test
. Joint line tenderness

Correct Answer & Explanation

. Positive pivot shift test

Explanation

While the Lachman test is highly sensitive, the pivot shift test is the most specific physical examination finding for an ACL tear. It dynamically reproduces the rotatory instability caused by the absent ligament.

Question 492

Topic: 5. Sports Medicine

A 9-year-old boy sustains a complete anterior cruciate ligament (ACL) tear. He has wide-open physes and significant skeletal growth remaining. Which of the following surgical techniques minimizes the risk of growth arrest?

. Transphyseal reconstruction with bone-patellar tendon-bone autograft
. Transphyseal reconstruction with hamstring autograft
. Iliotibial band (MacNicol) physeal-sparing extra-articular reconstruction
. Nonoperative management with physical therapy until skeletal maturity
. Primary repair of the ACL with suture anchors

Correct Answer & Explanation

. Iliotibial band (MacNicol) physeal-sparing extra-articular reconstruction

Explanation

In prepubescent children with significant growth remaining (Tanner stages 1 and 2), physeal-sparing ACL reconstruction techniques, such as the ITB extra-articular reconstruction or all-epiphyseal techniques, minimize the risk of physeal arrest. Transphyseal techniques carry a higher risk of growth disturbance in this age group.

Question 493

Topic: 5. Sports Medicine

An 11-year-old male presents with vague knee pain. Radiographs reveal an osteochondritis dissecans (OCD) lesion on the lateral aspect of the medial femoral condyle. MRI shows no high T2 signal behind the lesion and intact overlying cartilage. What is the most appropriate initial management?

. Arthroscopic drilling of the lesion
. Arthroscopic fixation of the fragment
. Diagnostic arthroscopy and debridement
. Osteochondral autograft transfer
. Cessation of sports and immobilization/weight-bearing restriction as needed

Correct Answer & Explanation

. Cessation of sports and immobilization/weight-bearing restriction as needed

Explanation

Stable OCD lesions in skeletally immature patients (juvenile OCD) typically heal with nonoperative management, including activity modification and restricted weight-bearing. Surgical intervention is reserved for unstable lesions or failure of conservative treatment after 3 to 6 months.

Question 494

Topic: 5. Sports Medicine

A 6-year-old Asian female presents with a painless "snapping" and "clunking" in her right knee during terminal extension. She denies swelling or mechanical locking. Radiographs show mild widening of the lateral joint space. What is the most appropriate management?

. Arthroscopic partial meniscectomy
. Arthroscopic total meniscectomy
. Observation and reassurance
. Immobilization in a cylinder cast for 4 weeks
. Diagnostic arthroscopy with saucerization

Correct Answer & Explanation

. Observation and reassurance

Explanation

The presentation is classic for a discoid lateral meniscus. In an asymptomatic or completely painless snapping knee without locking or effusion, the recommended management is observation and reassurance.

Question 495

Topic: Knee Sports
A 10-year-old girl falls off her bicycle and sustains a hyperextension injury to her knee. Radiographs reveal a completely displaced, non-comminuted fracture of the tibial spine (Meyers and McKeever Type III). What is the optimal treatment?
. Closed reduction and long-leg casting in 20 degrees of flexion
. Closed reduction and long-leg casting in full extension
. Arthroscopic or open reduction and internal fixation
. Non-weight bearing in a hinged knee brace for 6 weeks
. Excision of the avulsed fragment and ACL reconstruction

Correct Answer & Explanation

. Arthroscopic or open reduction and internal fixation

Explanation

Meyers and McKeever Type III fractures are completely displaced and often have interposed tissue preventing closed reduction. They require arthroscopic or open reduction and internal fixation using sutures, wires, or screws.

Question 496

Topic: Knee Sports

During medial patellofemoral ligament (MPFL) reconstruction, identifying the correct femoral attachment is crucial for restoring normal kinematics. Which of the following best describes the anatomical location of the MPFL femoral origin?

. Between the medial epicondyle and adductor tubercle
. Anterior to the medial epicondyle
. Distal to the joint line on the medial tibia
. Directly on the medial collateral ligament insertion
. Proximal to the adductor tubercle

Correct Answer & Explanation

. Between the medial epicondyle and adductor tubercle

Explanation

The MPFL femoral origin is located between the medial epicondyle and the adductor tubercle, slightly proximal and posterior to the medial epicondyle. This location corresponds to Schottle's point on lateral radiographs. Improper tunnel placement here is the most common cause of MPFL graft failure.

Question 497

Topic: 5. Sports Medicine

A 9-year-old girl (Tanner stage 1) sustains a midsubstance anterior cruciate ligament (ACL) tear. Her parents opt for surgical reconstruction. Which of the following techniques is most appropriate to minimize the risk of growth arrest?

. Transphyseal bone-patellar tendon-bone autograft
. Transphyseal hamstring autograft
. Iliotibial band extra-articular physeal-sparing reconstruction
. Primary repair of the ACL with internal bracing
. Conservative management with a hinged knee brace until skeletal maturity

Correct Answer & Explanation

. Iliotibial band extra-articular physeal-sparing reconstruction

Explanation

In prepubescent children with significant growth remaining (Tanner stage 1), an all-epiphyseal or physeal-sparing extra-articular (e.g., IT band) reconstruction is recommended. Transphyseal techniques risk growth arrest and angular deformity in this age group.

Question 498

Topic: Knee Sports

A 14-year-old boy presents with vague knee pain and occasional catching. Radiographs reveal an osteochondritis dissecans (OCD) lesion. What is the most common anatomical location for this lesion in the knee?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the medial femoral condyle
. Lateral aspect of the lateral femoral condyle
. Medial aspect of the lateral femoral condyle
. Central trochlear groove

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The classic and most common location for an OCD lesion in the knee is the lateral aspect of the medial femoral condyle. This accounts for approximately 70-80% of knee OCD lesions.

Question 499

Topic: Knee Sports

A 6-year-old girl presents with a painless snapping sensation on the lateral aspect of her knee during extension. Which of the following MRI findings is most likely associated with her condition?

. Double PCL sign
. Continuity of the anterior and posterior horns on 3 consecutive sagittal slices
. Bone bruise pattern on the lateral femoral condyle and posterolateral tibia
. High signal intensity within the medial meniscus reaching the articular surface
. Thickened medial patellofemoral ligament

Correct Answer & Explanation

. Continuity of the anterior and posterior horns on 3 consecutive sagittal slices

Explanation

The clinical presentation is classic for a discoid lateral meniscus, which presents as a snapping knee in children. On MRI, it is diagnosed when three or more consecutive sagittal slices show continuity of the anterior and posterior horns (bowtie sign).

Question 500

Topic: Knee Sports
During medial patellofemoral ligament (MPFL) reconstruction, identifying the correct femoral attachment point is critical. Which of the following best describes the anatomic location of the femoral footprint of the MPFL?
. Anterior to the medial epicondyle and proximal to the adductor tubercle
. Between the medial epicondyle and the adductor tubercle
. Distal to the medial epicondyle and posterior to the superficial MCL
. Proximal to the adductor tubercle and posterior to the medial epicondyle
. Directly on the medial joint line

Correct Answer & Explanation

. Between the medial epicondyle and the adductor tubercle

Explanation

The MPFL femoral insertion (Schöttle point) is located in the saddle-shaped depression between the medial epicondyle and the adductor tubercle. Anatomical placement is crucial to restore normal patellofemoral kinematics.

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